Ebola cases pass 2k as crisis escalates • Hacker News Board

Re: Ebola cases pass 2k as crisis escalates

#81

Post by _djo_ » Wed, Jun 05, 2019, 6:13 PM UTC

fredgrott wrote: post #12

seems like a role of UN troops to maintain peace so that WHO workers can do their jobs

That is part of what the UN troops are attempting to do, but it's an impossibly difficult task. There are far too few troops for the size of the area and population size they need to defend, and that's before you take into account issues like logistics, the unwillingness of some national contingents to deploy far from bases, etc.

To provide some context, just the eastern provinces of the DRC, where most of the violence is concentrated, have a population of more than 20 million people and a land area larger than Germany. The UN mission in the DRC, MONUSCO, has just 15 000 troops. A figure which shrinks annually as a result of US-forced budget cuts.

Those budget cuts (which the Trump administration has loudly boasted about, FWIW) have also severely depleted the aviation budget, preventing MONUSCO from being able to deploy as many attack helicopters as its commanders say it needs to go after armed groups and reducing its ability to transport troops by air. This forces them to take long, slow journeys on the country's dilapidated road network, even in cases of urgent responses. During the rainy season it can take hours to travel a few kilometres despite having specialised vehicles.

Add to that the fact that government troops are often corrupt and local commanders can be in league with some of the rebel groups, and it's a pretty difficult mission at the best of times.

Re: Ebola cases pass 2k as crisis escalates

#82

Post by TallGuyShort » Wed, Jun 05, 2019, 6:26 PM UTC

i_am_nomad wrote: post #38

To those of you worried about a global outbreak: USAMRIID is closing in on a highly effective (near 100%) treatment for Ebola. So far it is 100% successful in macaques, which is a good animal model for the disease in humans. The project lead spoke to my research group - his talk about Ebola, and some of the cultural and geographic challenges in fighting it, was fascinating.

I'm curious to learn more about how well we can ramp up production and distribution of such drugs in the event of a fast-moving pandemic. With Ebola you have 1-2 weeks after symptoms before death is likely. You have a few more weeks after exposure, but you might not know you're exposed and I would assume the treatment needs time and can't save you at the last minute. If everyone around was clamoring for treatment, could you get your hands on it that fast?

Re: Ebola cases pass 2k as crisis escalates

#83

Post by Balgair » Wed, Jun 05, 2019, 6:28 PM UTC

waynecochran wrote: post #28

Could someone explain the graph used in the article where the y-axis is labeled as "cumulative" -- does this mean that each bin includes the sums from the previous bins? If so, then this will always be a non-decreasing graph. Ebola outbreaks are horrible, but it doesn't do any good to use stupid graphs like this to make it look worse than it is.

WHO reports are much better overall: https://www.who.int/ebola/situation-reports/drc-2018/en/

Re: Ebola cases pass 2k as crisis escalates

#84

Post by Balgair » Wed, Jun 05, 2019, 6:45 PM UTC

The WHO reports are very informative as well: https://www.who.int/ebola/situation-reports/drc-2018/en/

The latest report (4 June 2019): https://apps.who.int/iris/bitstream/handle/10665/325126/SITR...

Figure 1 on Page 3 is a good-ish overall representation of the situation. Ebola is sustaining itself. It hasn't gone geometric yet, but it could at nearly any time, if not already.

One important thing to note is that though it may seem that in the last 3 weeks the epidemic has been tapering off, that is an artifact of the reporting situation there. There is a significant lag in identification of deaths and causes. Feel free to look back over the other reports to see this reporting lag effects.

Another thing to note is that North-Kivu province is about the same size as West Virginia with about 2.5X the population. Goma, the capital there, has a population of about that of San Jose proper.

Combined with other sources that other HNers have linked, the Nature article is correct to sound the alarm here. The Ebola fighters are trying their best (despite the complicated social situations, weather, gear, humidity, and resource limitations), but Ebola is not quitting either. This situation is not something to wave away and is very deserving of international attention.

Re: Ebola cases pass 2k as crisis escalates

#85

Post by Balgair » Wed, Jun 05, 2019, 6:52 PM UTC

georgehayduke wrote: post #19

I am amazed at the bravery of the medical staff, health professionals and volunteers who are trying to contain Ebola in the DRC. Not only are they potentially exposed to the deadly disease, they have to content with violent attacks from the population they're trying to help. It sounds incredibly complex - a mix of political mistrust, lack of education and difficult terrain making containment difficult. While spreadin…

The weather in Goma, the capital of North-Kivu province, is going to be ~75F (24C) and ~80% humidity tomorrow.

Imagine having to wear all that protective gear in 80% humidity, limiting your visibility and hearing, limiting your bathroom habits and ability to rehydrate and eat, for hours at a time, in potentially hostile social situations, while dealing with a person or a corpse that you have a very good suspicion could infect and kill you with literal Ebola, a disease that will liquify you from the inside, every day, for months at a time, with no end in sight, and the virus seemingly 'winning.'

Absolute heroes.

Re: Ebola cases pass 2k as crisis escalates

#86

Post by HarryHirsch » Wed, Jun 05, 2019, 7:24 PM UTC

phkahler wrote: post #68

HarryHirsch wrote: post #43

Earlier quoted context omitted.

They do: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5580494/ But the jury is still out on what evolutionary processes are ongoing. Is the virus adapting to its new host and consequently evolving more slowly, or is it quickly developing increased transmissibility? It's not quite clear.

The best evolutionary path from virus point of view is to reduce lethality so the host can spread it longer. I thought I read that HIV did something similar and used to be more deadly - even without modern treatment. Problem with Ebola is that its transmission among humans is via the same thing that kills humans.

It depends on the environment. Mortality of cholera is high (~ 60 % if untreated), but by spreading abundantly the bacterium finds a supply of new victims.

I seem to remember a study from ages ago where they compared strains of HIV from South Africa and Japan. Condom usage in South Africa is low, so the virus evolved to develop a high viral load quickly. In Japan the opposite was true, condom usage was high, the strains that caused the victim to die early became extinct.

Re: Ebola cases pass 2k as crisis escalates

#87

Post by favorited » Wed, Jun 05, 2019, 7:25 PM UTC

As always when an Ebola discussion happens, I want to recommend people interested in the origins of the disease read Richard Preston's 'The Hot Zone.' It details the history of the disease (as well as some related filoviruses, like Marburg), specifically following several doctors and researchers as they track outbreaks and treat victims.

It was turned into a 6-episode miniseries on National Geographic (just aired last week), but the book is 100% worth the read if you're interested in the topic.

Re: Ebola cases pass 2k as crisis escalates

#88

Post by i_am_nomad » Wed, Jun 05, 2019, 7:36 PM UTC

jlmorton wrote: post #80

i_am_nomad wrote: post #38

To those of you worried about a global outbreak: USAMRIID is closing in on a highly effective (near 100%) treatment for Ebola. So far it is 100% successful in macaques, which is a good animal model for the disease in humans. The project lead spoke to my research group - his talk about Ebola, and some of the cultural and geographic challenges in fighting it, was fascinating.

U.S. Army Medical Research Institute for Infectious Diseases is doing the important testing work, but the novel drug is GS-5734 / Remdesivir from Gilead Sciences. https://www.gilead.com/purpose/advancing-global-health/ebola

Right, thank you for the clarification, I should have been specific about that.

Re: Ebola cases pass 2k as crisis escalates

#89

Post by i_am_nomad » Wed, Jun 05, 2019, 7:39 PM UTC

mieseratte wrote: post #45

i_am_nomad wrote: post #38

To those of you worried about a global outbreak: USAMRIID is closing in on a highly effective (near 100%) treatment for Ebola. So far it is 100% successful in macaques, which is a good animal model for the disease in humans. The project lead spoke to my research group - his talk about Ebola, and some of the cultural and geographic challenges in fighting it, was fascinating.

Could you elaborate on those challenges?

For one thing, some of the burial practices and rituals in the region pose significant risks of communicating Ebola. And, when health workers recommend suspending those practices, those recommendations are not well-received.

Re: Ebola cases pass 2k as crisis escalates

#90

Post by i_am_nomad » Wed, Jun 05, 2019, 7:41 PM UTC

TallGuyShort wrote: post #82

i_am_nomad wrote: post #38

To those of you worried about a global outbreak: USAMRIID is closing in on a highly effective (near 100%) treatment for Ebola. So far it is 100% successful in macaques, which is a good animal model for the disease in humans. The project lead spoke to my research group - his talk about Ebola, and some of the cultural and geographic challenges in fighting it, was fascinating.

I'm curious to learn more about how well we can ramp up production and distribution of such drugs in the event of a fast-moving pandemic. With Ebola you have 1-2 weeks after symptoms before death is likely. You have a few more weeks after exposure, but you might not know you're exposed and I would assume the treatment needs time and can't save you at the last minute. If everyone around was clamoring for treatment, co…

Sorry, I don’t know much about large-scale production of that type of compound, it’s not my field. But, I would question the premise, in that Ebola is not a likely candidate for a fast-moving pandemic.